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Gently swirl do not shake vigorously: Vigorous shaking can denature the peptide

The mechanism involved is not known, but the cardiovascular actions will importantly support the future use of GLP-1 receptor agonists, which are already generally recommended as second line therapies for patients with metformin failure (120)

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For patients without specific cardiovascular risk factors, baseline vital signs including heart rate should be documented before initiating tirzepatide, with routine monitoring at follow-up visits as part of standard care

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